By Alex R. Thiersch, CEO of the American Med Spa Association (AmSpa)

The recent arrest of licensed vocational nurse (LVN) Michelle Bogle has shaken the medical spa industry to its core. Bogle, an employee of Savvy Chic Medspa in Spring, Texas, is accused of practicing medicine without a license for administering Botox injections, something that many, many LVNs—and much less qualified individuals—have done and are doing. Bogle's arrest and prospective prosecution have far-reaching consequences for those in the medical aesthetic industry, but this sort of enforcement, while somewhat surprising, was inevitable, so it's up to medical spas everywhere to maintain compliance with their states' rules and regulations.

I could go to practically any medical spa in the country and find something that it's doing incorrectly, from a minor OSHA violation to a HIPAA breach to the improper practice of medicine in the form of improper delegation or supervision. In AmSpa's 2017 Medical Spa State of the Industry Study, it found that 37% of medical spas that responded to the survey admitted that they did not do any sort of in-person good-faith exam prior to a medical treatment. (Frankly, I think the actual number is closer to 50%, but some respondents likely weren't being entirely truthful.) The fact that Savvy Chic was conducting exams over FaceTime is one of the reasons why the investigation that netted Bogle was launched.

Any treatment that impacts living tissue—which encompasses most of the treatments offered at a medical spa—is a medical treatment and requires a full exam before it can be administered. If roughly half of the medical spas in operation aren't doing this, we as an industry have a long way to go. And if you're shocked by the charge against Bogle, you shouldn't be—administering Botox is a medical procedure and she is not qualified to perform it, so therefore, she was practicing medicine without a license. Even though it happens constantly in medical spas all over the country, that doesn't make it right and, in fact, indicates the immaturity of the industry.

It is high time for everyone in the medical aesthetic industry to start taking this a lot more seriously than they are. If this industry is going to survive and grow and thrive, it is crucial that this starts being controlled. At a minimum, we have to understand the practice of medicine, as well as the proper delegation and supervision of medical treatments.

Another finding of AmSpa's 2017 Medical Spa State of the Industry Study was that only 7% of the respondents said they had been investigated by a government agency. My concern is that, because enforcement has traditionally been so lax, there is not much urgency for medical spas to fix their compliance issues. However, a rise in enforcement has taken place over the past couple years, and I suspect that if we were to ask the same question today, the number of medical spas admitting they have been investigated would be significantly higher.

Compliance is never a problem until it's a problem, but we as an industry need to want to do better, and we need to do it regardless of the threat of enforcement. The medical aesthetic industry will not be taken seriously as long as its practitioners are seen making perp walks on the nightly news. Everyone at every medical spa must respect the need for compliance and do what they can to achieve it. The Wild West days of years past are over, and the industry must evolve to become everything it possibly can be.